Conservative treatment of meniscal tears in anterior cruciate ligament reconstruction

• Stable peripheral meniscal tears of less than 10 mm could be “left in-situ” at time of ACL reconstruction
• We retrospectively evaluated 175 cases of ACL reconstruction with unilateral medial or lateral meniscal tears
• In 83 patients a meniscal tears was left untreated (45 medial menisci and 38 lateral menisci)
• The medial meniscus in stable knee had higher failure rate compared with lateral meniscus
• The red-red zone had lower revision rate compared with red-white zone
• The overall failure rate in patients with objective residual laxity was significantly higher
• Medial meniscal tears have higher prevalence of re-tearing and residual laxity significantly increased the failure rate

BackgroundManagement of small and stable meniscal tears within the vascular zone at the time of anterior cruciate ligament (ACL) reconstruction is controversial. The purpose of this study was to evaluate the outcome of meniscal tear left in situ at the time of ACL reconstruction.MethodsUsing the IKDC, KT-1000 and the Tegner Activity Score (TAS), we retrospectively analysed 175 cases of ACL reconstruction with meniscal tears performed from 2006 to 2012. Patients with residual laxity on clinical assessment were identified and considered as a subgroup. Clinical outcome and failure rate were evaluated.ResultsIn 83 patients (47.4%), a meniscal tear was left in situ at the time of ACL reconstruction: 45 were medial and 38 were lateral. Patients were clinically reassessed with a minimum follow-up of 24 months. The overall failure rate of conservative meniscal treatment in patients with objective residual laxity was 87.5%, and 6.7% in patients with a stable knee (P < 0.001). Those with stable knees had higher postoperative IKDC subjective scores (P = 0.0022) and TAS (P < 0.0001). Patients without residual laxity had higher failure rate for the medial meniscus compared with lateral meniscus - 10.5% versus 2.7% (P=0.36)—and the red-red zone had lower revision rate compared with the red-white zone (P = 0.0322).ConclusionsThe conservative treatment of small and stable peripheral tears of the medial and lateral menisci had low failure rate and no described complications. In our series residual laxity significantly increased the failure rate.Level of evidencelevel IV, therapeutic case series